Psych Nurse Practitioner - Crisis - Multiple Site

Community Bridges, Inc. (CBI) is an integrated behavioral healthcare agency offering a variety of programs throughout Arizona. CBI provides residential, outpatient, inpatient, patient-centered medical homes, medication-assisted treatment, and crisis services to individuals experiencing crisis, opioid use disorder, homelessness, and mental illness.

About the Role

At Community Bridges, Inc. (CBI), a psychiatric practitioner is an integral specialty for our whole-person approach in our integrated system of physical, psychiatric, and addiction services. The scope of practice of psychiatric practitioner in the inpatient setting will see adults 18 and older, all genders, all socio-economic backgrounds, complex medical history, and co-occurring psychiatric disorders. Psychiatric practitioners at CBI will be expected to provide patient-centered, evidence-based care for patients as well as serve as patient advocates in all health-related matters, including the appropriate use of specialists, health services, and community resources.

CBI is looking for PMHNPs for the following shifts:

• PMHNP/FNP – for Crisis Sobriety Center – AM/PM shifts (Sunday – Tuesday, Rotating Wednesday) (Rotating Wednesday, Thursday - Saturday).
• PMHNP – (SMI Caseload) - Full time on site, Mesa location; 8AM-4PM Monday – Friday.
• PMHNP – ACT/FACT – Full time on site, Central Phoenix 8AM-5PM Monday – Friday.

Responsibilities

• Complete Urgent Psychiatric and/or Addiction Medicine evaluations with all patients referred to the 23-hour observation unit from all referral sources including, but not limited to, hospitals, urgent care centers, law enforcement, and other medical practitioners for the purposes of assessment, diagnosis, and treatment recommendations.
• Complete Urgent Psychiatric Assessment and/or Addiction Medicine, Ambulatory Detox, or Physical Health Assessments with patients who have been identified by CBI screening staff.
• Coordinate with one another when admitting, transferring, or discharging a patient to a different CBI program or level of care and document in the medical record to ensure a smooth transition.
• Be available or initiate doc-to-doc communication and coordination of care and document it appropriately.
• Evaluate all patients on the unit at least daily to provide necessary adjustments in treatment and discharge planning.
• Provide assessment for the appropriate use of seclusion and restraint in accordance with CBI policy, including documentation of current behaviors, known medical conditions, known psychiatric/behavioral health conditions, and any current medication.
• Write or sign an order for seclusion or restraint immediately if at the facility, or within three hours if given verbally, including:
  • The date and time that the restraint or seclusion was ordered.
  • The specific restraint or seclusion ordered.
  • If chemical restraint is ordered, the drug names, strength, dosage, route of administration, and symptoms being treated.
  • Maximum duration authorized (not to exceed three continuous hours).
• Complete and document an assessment within one hour after order for restraint or seclusion takes place, including current behavior, reaction to intervention, patient’s current medical condition, and whether to continue or terminate the restraint or seclusion.
• Write a release order or document a second order at the end of three hours if restraint or seclusion needs to be continued.
• Review cases and discharge plans during rounds with assigned CBI medical staff, document and sign full discharge orders, and follow-up recommendations within 24 hours of discharge.
• Remain on the unit for the entirety of the scheduled shift. Deviations require prior approval from the CMO or designee.
• Complete Application for Involuntary Evaluation and Application for Emergency Admission. Applications are reviewed by a qualified practitioner within two hours of receipt for acceptance decision.
• Immediately notify the Admission Coordinator of the decision regarding applications. Applications determined as not acceptable must be staffed with the CBI Medical Director prior to not accepting the application and prior to dropping the application post-evaluation.
• Complete Practitioner Admission Orders on admission (in person or verbally to a nurse) and sign by the admitting practitioner within 24-hours of admission.
• Conduct daily staffing and rounds, including:
  • Psychiatric evaluation for everyone admitted to the 23-Hour Observation Unit at minimum once every 24 hours, or sooner if clinically appropriate.
  • Review cases with RN and Crisis Specialist during rounds as part of the discharge planning process.
  • Document rounds in progress note.
  • Review cases with oncoming practitioner at the end of each shift.
• Maintain treatment of physical health and/or coordination with PCP and other prescribers while in treatment.
• Coordinate with one another when discharging, admitting, or transferring a patient to a different CBI program or level of care and document in the medical record to ensure a smooth transition.
• Complete a psychiatric evaluation and document it in the patient file for everyone admitted to the inpatient behavioral health facility.
• Write or sign an order for a pain management evaluation if clinically indicated and outside the scope of the attending medical practitioner.
• Provide necessary documentation and treatment for patients under petition or court-ordered treatment.
• Document and sign full discharge orders and follow-up recommendations within 24-hours of discharge, including review of the discharge plan with the patient.
• Evaluate each patient for ongoing mental health/psychiatric care and physical health issues prior to discharge and document in the electronic health record.
• Complete orientation as directed by CBI, including shadowing another CBI practitioner prior to working with patients.
• Obtain and maintain Suboxone waiver to treat the maximum number of patients for which the practitioner is eligible, and maintain necessary patient data logs as required when treating patients with buprenorphine.
• Provide evidence of CPR/First Aid prior to working with CBI patients and provide documentation of renewal every two years.
• Participate in quality management initiatives and correct any identified areas of deficiency within 72 hours; exceptions must be approved by the Director of Medical Practice in consultation with the CBI Medical Director.
• Maintain a minimum 85% compliance with documentation requirements.
• Adhere to appointment scheduling protocols assigned by the medical director and monitored by the medical management team.
• Maintain a minimum 85% patient satisfaction. If performance falls below 85%, submit a plan of correction to the Medical Director. If performance falls below 85% for two consecutive months, the practitioner will be removed from the schedule and will not receive compensation during this time.
• Maintain a minimum of 75% follow-up rate.
• Complete and document all medication assessments and informed consents by the end of assigned shift or within 24 hours of seeing the patient.
• Review the Controlled Substance Prescription Monitoring Program prior to treatment and coordinate care with other prescribing practitioners.
• Utilize e-Prescribing for all patient prescriptions as established in the CBI electronic medical record.
• Attend regular staffing and rounds on assigned patients; participate in the development of the patient’s treatment plan; provide clinical expertise for the treatment team for patient care; give appropriate direction and provide effective communication about patient care activities.
• Support utilization review activities by clearly documenting admission medical necessity and continued stay necessity, including completion of certification of need for Level I admissions or facilitating completion by a physician if the practitioner is a Nurse Practitioner or Physician Assistant.
• Support utilization management activities by providing reviews when requested by payors.
• Promote collaborative patient care by communicating with referring and receiving professionals.
• Attend and actively participate in practitioner meetings; actively participate in any state, regulatory, or accreditation surveys; participate in peer review activities and performance improvement projects.
• Comply with agreed-upon work schedules to provide coverage at the facility and meet the clinical and business needs. CBI maintains the right to schedule Medical Professionals at any facility and will make every attempt to establish routine schedules.
• Give a minimum of 60 days’ notice for time off and coordinate with peers to arrange for coverage for scheduled shifts.
• Notify Director of Medical Practice and Medical Director in the case of an emergency and inability to cover a scheduled shift.
• Adhere to all policies and procedures established by CBI.
• Complete documentation within 24 hours of visit. If documentation is not complete by the allotted timeframe, notify the Director of Medical Practice.
• Participate in training new clinical staff of the same specialty or experience, with adjustments made to practitioner schedules during training hours if it impacts patient care.
• Attend educational meetings as deemed appropriate for their specialty, including quarterly practitioner meetings. A minimum of 3 quarterly meetings per year is required.

Schedule

• Sunday – Tuesday, Rotating Wednesday: 7AM-7PM
• Rotating Wednesday, Thursday – Saturday: 7AM-7PM
• PMHNP – (SMI Caseload): 8AM-4PM Monday – Friday (Mesa location)
• PMHNP – ACT/FACT: 8AM-5PM Monday – Friday (Central Phoenix location)